Antineoplastic Drugs
A patient will be receiving mitoxantrone (Novantrone), 12 mg/m2/day every 3 weeks, as part of treatment for prostate cancer. Each dose is mixed into a 50-mL bag of D5W and needs to infuse over 15 minutes. The infusion pump delivers the dose at milliliters per hour. Identify the nurse will set the pump to infuse at what rate. _______
200 mL/hr 15 minutes = 0.25 hour.50 mL:0.25 hour :: x mL:1 hour.(50 × 1) = (0.25 × x); 50 = 0.25x; x = 200 mL/hr.
A patient is to receive a daily dose of fludarabine (Fludara), 25 mg/m2/day for 5 consecutive days. Each dose is diluted in a 125-mL bag of normal saline and is to infuse over 30 minutes. The nurse will set the infusion pump to what rate in milliliters per hour?
250 mL 30 minutes = 0.5 hour.125 mL:0.5 hour :: x mL:1 hour.(125 × 1) = (0.5 × x); 125 = 0.5x, x = 250; set the pump to infuse at 250 mL/hr.
A female patient is receiving palliative therapy with androgen hormones as part of treatment for inoperable breast cancer. The nurse will discuss with the patient which potential body image changes that may occur as adverse effects? A. Hirsutism and acne B. Weight gain C. Flushing and hot flashes D. Alopecia and body odor
A
A patient is receiving doxorubicin (Adriamycin) as part of treatment for ovarian cancer. Which of these is a possible adverse effect of doxorubicin? A. Cardiotoxicity B. Pulmonary toxicity C. Neurotoxicity D. Hyperuricemia
A
Interleukin-2 (IL-2) is used as adjuvant therapy for a patient with metastatic renal cell carcinoma. Which information should the nurse include when explaining the purpose of this therapy to the patient? A. IL-2 enhances the body's immunologic response to tumor cells. B. IL-2 prevents bone marrow depression caused by chemotherapy. C. IL-2 protects normal cells from harmful effects of chemotherapy. D. IL-2 stimulates cancer cells in their resting phase to enter mitosis.
A
One patient has cancer of the bone; another has cancer in the connective tissues of the thigh muscles; a third patient has cancer in the vascular tissues. Which of these is the correct term for these tumors? A. Sarcoma B. Leukemia C. Carcinoma D. Lymphoma
A
The nurse assesses a patient with non-Hodgkin's lymphoma who is receiving an infusion of rituximab (Rituxan). Which assessment finding would require the most rapid action by the nurse? A. Shortness of breath B. Shivering and chills C. Muscle aches and pains D. Temperature of 100.2° F (37.9° C)
A
The nurse is monitoring a patient who has severe bone marrow suppression following antineoplastic drug therapy. Which is considered a principal early sign of infection? A. Fever B. Diaphoresis C. Tachycardia D. Elevated white blood cell count
A
During treatment of a patient who has brain cancer, the nurse hears the oncologist mention that the patient has reached the "nadir." The nurse knows that this term means which of these? A. The lowest level of neutrophils reached during therapy. B. The highest level of neutrophils reached during therapy. C. The point at which the adverse effects of chemotherapy will stop. D. The point at which the cytotoxic action against cancer cells is the highest.
A The lowest neutrophil count reached after a course of chemotherapy is known as the nadir. The other options are incorrect.
When caring for a patient who is pancytopenic, which action by unlicensed assistive personnel (UAP) indicates a need for the nurse to intervene? A. The UAP assists the patient to use dental floss after eating. B. The UAP adds baking soda to the patient's saline oral rinses. C. The UAP puts fluoride toothpaste on the patient's toothbrush. D. The UAP has the patient rinse after meals with a saline solution.
A Use of dental floss is avoided in patients with pancytopenia because of the risk for infection and bleeding. The other actions are appropriate for oral care of a pancytopenic patient.
When a patient is receiving cisplatin (Platinol-AQ) chemotherapy, the nurse will monitor for which adverse effects? (Select all that apply.) A. Tinnitus B. Heart failure C. Hearing loss D. Elevated blood urea nitrogen and creatinine levels E. Numbness or tingling in the extremities F. Elevated glucose and ketone levels
A, C, D, E
Methotrexate is ordered for a patient with a malignant tumor, and the nurse is providing education about self-care after the chemotherapy is given. Which statements by the nurse are appropriate for the patient receiving methotrexate? (Select all that apply.) A. Report unusual bleeding or bruising. B. Hair loss is not expected with this drug. C. Prepare for hair loss. D. Avoid areas with large crowds or gatherings. E. Avoid foods that are too hot or too cold or rough in texture. F. Restrict fluid intake to reduce nausea and vomiting.
A, C, D, E Counsel patients who are taking methotrexate to expect hair loss and to report any unusual bleeding or bruising. Because of the possibility of infection, avoid areas with large crowds or gatherings. Foods that are too hot or too cold or rough in texture may be irritating to the oral mucosa. Fluid intake is to be encouraged to prevent dehydration.
When giving chemotherapy as cancer treatment, the nurse recognizes that toxicity to rapidly growing normal cells also occurs. Which rapidly growing normal cells are also harmed by chemotherapy? (Select all that apply.) A. Bone marrow cells B. Retinal cells C. Hair follicle cells D. Nerve myelin cells E. Gastrointestinal (GI) mucous membrane cells
A, C, E
The nurse is assessing a patient who is receiving chemotherapy with an alkylating drug. Which assessment findings would be considered indications of an oncologic emergency? (Select all that apply.) A. Dry, "scratchy," or "swollen" throat B. Loss of hair C. Decreased red blood cell count D. White patches in the mouth or throat E. Temperature of 100.7° F (38.2° C) F. Decreased urine output
A, D, E, F
A patient, diagnosed with lymphoma, has an allergy to one of the proposed chemotherapy drugs. The tumor has not responded to other types of treatment. The nurse expects the oncologist to follow which course of treatment? A. The physician will choose another drug to use. B. The chemotherapy will be given along with supportive measures to treat a possible allergic reaction. C. The patient will receive reduced doses of chemotherapy for a longer period of time. D. The chemotherapy cannot be given because of the patient's allergy.
B
The nurse administers an IV vesicant chemotherapeutic agent to a patient. Which action is most important for the nurse to take? A. Infuse the medication over a short period of time. B. Stop the infusion if swelling is observed at the site. C. Administer the chemotherapy through a small-bore catheter. D. Hold the medication unless a central venous line is available.
B
The nurse assesses a patient who is receiving interleukin-2. Which finding should the nurse report immediately to the health care provider? A. Generalized muscle aches B. Crackles at the lung bases C. Reports of nausea and anorexia D. Oral temperature of 100.6° F (38.1° C)
B
The nurse is evaluating the laboratory results of a patient who has received chemotherapy. The loss of which blood cell leads to lack of energy, fatigue, intolerance of activity and hypoxemia? A. White blood cells B. Red blood cells C. Platelets D. Albumin
B
The nurse is teaching a class about the various chemotherapy drugs. Which of these statements explains why alkylating drugs are also called "cell cycle-nonspecific drugs"? A. They are cytotoxic during a specific cell cycle. B. They are cytotoxic in any phase of the cell cycle. C. They are effective against several types of neoplasms. D. They are more highly differentiated than cell cycle-specific drugs.
B
The nurse supervises the care of a patient with a temporary radioactive cervical implant. Which action by unlicensed assistive personnel (UAP), if observed by the nurse, would require an intervention? A. The UAP flushes the toilet once after emptying the patient's bedpan. B. The UAP stands by the patient's bed for 30 minutes talking with the patient. C. The UAP places the patient's bedding in the laundry container in the hallway. D. The UAP gives the patient an alcohol-containing mouthwash to use for oral care.
B
When giving cisplatin (Platinol-AQ), the nurse is aware that adverse effect of this drug is which condition? A. Alopecia B. Kidney damage C. Cardiotoxicity D. Stomatitis
B
A patient is receiving high doses of methotrexate and is experiencing severe bone marrow suppression. The nurse expects which intervention to be ordered with this drug to reduce this problem? A. A transfusion of whole blood B. Leucovorin rescue C. Therapy with filgrastim (Neupogen) D. Administration of allopurinol (Zyloprim)
B High-dose methotrexate is associated with bone marrow suppression, and it is always given in conjunction with the rescue drug leucovorin, which is an antidote for folic acid antagonists. Basically, leucovorin rescues the healthy cells from methotrexate. The other options are incorrect.
The nurse is teaching about infection-prevention measures with a patient who is receiving antineoplastic drug therapy. During a Teach-Back session, which statement by the patient indicates the need for further education? A. "I will avoid those who have recently had a vaccination." B. "I will eat only fresh fruits and raw vegetables." C. "I will report a sore throat, cough, or low-grade temperature." D. "It is important for both my family and me to practice good handwashing."
B Patients who are neutropenic and susceptible to infections need to adhere to a low-microbe diet by washing fresh fruits and vegetables and making sure foods are well cooked. The other options are incorrect.
A patient is receiving a third session of chemotherapy with daunorubicin (Cerubidine). The nurse will assess the patient for which signs of a potential severe toxic effect of this drug? A. Tinnitus and hearing loss B. Numbness and tingling in the fingers C. A weight gain of 2 pounds or more in 24 hours D. Decreased blood urea nitrogen and creatinine levels
C
A patient is receiving irinotecan (Camptosar), along with other antineoplastic drugs, as treatment for ovarian cancer. The nurse will monitor for which potentially life-threatening adverse effect that is associated with this drug? A. Severe stomatitis B. Bone marrow suppression C. Delayed-onset cholinergic diarrhea D. Immediate and severe nausea and vomiting
C
A patient who has been on methotrexate therapy is experiencing mild pain. The patient is asking for aspirin for the pain. The nurse recognizes that which of these is true in this situation? A. The aspirin will aggravate diarrhea. B. The aspirin will mask signs of infection. C. Aspirin can lead to methotrexate toxicity. D. The aspirin will cause no problems for the patient on methotrexate.
C
During chemotherapy, a patient develops severe diarrhea caused by a vasoactive intestinal peptide-secreting tumor (VIPoma). The nurse expects to administer which drug for this problem? A. Dexrazoxane (Zinecard) B. Allopurinol (Zyloprim) C. Octreotide (Sandostatin) D. Bismuth subsalicylate (Pepto-Bismol)
C
The nurse is hanging a new infusion bag of a chemotherapy drug, but the tubing becomes disconnected and a small amount of the solution drips onto the floor. Which action by the nurse is appropriate? A. Let it dry, and then mop the floor. B. Wipe the area with a disposable paper towel. C. Use a spill kit to clean the area. D. Ask the housekeeping department to clean the floor.
C
What is the nurse's priority action if extravasation of an antineoplastic drug occurs during intravenous (IV) administration? A. Reduce the infusion rate. B. Discontinue the IV, and apply warm compresses. C. Stop the infusion immediately, but leave the IV catheter in place. D. Change the infusion to normal saline, and inject the area with hydrocortisone.
C
A patient is receiving her third course of 5-fluorouracil therapy and knows that stomatitis is a potential adverse effect of antineoplastic therapy. What will the nurse teach her about managing this problem? A. "You can take aspirin to prevent stomatitis." B. "Be sure to watch for and report black, tarry stools immediately." C. "You need to increase your intake of foods containing fiber and citric acid." D. "Be sure to examine your mouth daily for bleeding, painful areas, and ulcerations."
D
The nurse is developing a plan of care for a patient who is experiencing gastrointestinal adverse effects, including anorexia and nausea, after the first course of antineoplastic therapy. What is an appropriate outcome for this patient when dealing with this problem? A. The patient will eat three balanced meals a day within 2 days. B. The patient will return to normal eating pattern within 4 weeks. C. The patient will maintain normal weight by consuming healthy snacks as tolerated. D. The patient will maintain a diet of small, frequent feedings with nutrition supplements during therapy.
D
The nurse obtains information about a hospitalized patient who is receiving chemotherapy for colorectal cancer. Which information about the patient alerts the nurse to discuss a possible change in cancer therapy with the health care provider? A. Frequent loose stools B. Nausea and vomiting C. Elevated white blood count (WBC) D. Increased carcinoembryonic antigen (CEA)
D
The nurse reviews the laboratory results of a patient who is receiving chemotherapy. Which laboratory result is most important to report to the health care provider? A. Hematocrit 30% B. Platelets 95,000/μL C. Hemoglobin 10 g/L D. White blood cells (WBC) 2700/μL
D
Just before the second course of chemotherapy, the laboratory calls to report that the patient's neutrophil count is 450 cells/mm3. The nurse expects that the oncologist will follow which course of treatment? A. Chemotherapy will continue as scheduled. B. Chemotherapy will resume with a lowered dosage. C. Chemotherapy will resume after a transfusion of neutrophils. D. Chemotherapy will be withheld until the neutrophil count returns toward normal levels.
D The normal range for neutrophils is above 1500 cells/mm3. If neutrophils are decreased to levels of less than 500 cells/mm3 (neutropenia), there is risk for severe infection. Chemotherapy will be held until the count returns toward normal levels.
